Breast Augmentation

Breast augmentation or breast enlargement, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast.

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If you’re considering breast augmentation or breast enlargement

Breast augmentation or enlargement, technically called augmentation mammoplasty and more commonly known as a ‘boob job’, is a surgical procedure to enhance the size and shape of a woman’s breast. This might be done:

  • To enhance the body contour of a woman who feels her breast size is too small.
  • To correct a reduction in breast volume after pregnancy.
  • To balance a difference in breast size.
  • As a reconstructive technique following breast surgery or mastectomy.

By inserting an implant behind each breast, a surgeon can increase a woman’s bust line by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure – when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask us if there is anything you don’t understand about the procedure.
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The best candidates for breast augmentation

Breast augmentation can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

The best candidates for breast augmentation

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. By inserting an implant behind each breast, surgeons are able to increase a woman’s bustline by one or more bra cup sizes.

Other materials have been used to fill breast implants, but as yet none has proven as reliable as silicone or saline. I generally prefer to use silicone implants because they provide a better shape.

The safety of silicone implants has been extensively investigated over the past decade, and much of the controversy that was previously reported in the media has now been resolved.

You can obtain a free booklet that explains the risks and benefits of silicone breast augmentation by telephoning or writing to:

  • The Silicone Gel Breast Implants Independent Review Group
  • 9th Floor
  • Hannibal House
  • Elephant & Castle
  • London SE1 6TQ
  • Telephone: 0207 972 8000

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All surgery carries some uncertainty and risk

Breast enlargement or augmentation is relatively straightforward. But as with any operation, there are risks and potential complications associated with this procedure. The scar, usually in the groove below the breast, is 5-6cm long and may become red and lumpy.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control it and remove the accumulated blood.

A very small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Breast Augmentation

Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to breastfeed.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the shell to leak.

If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate. There may be a change in the shape or firmness of the breast. Both types of break will require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove every particle of the silicone gel in the breast tissue if a rupture occurs.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective-tissue disorders”.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology centre where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Mammograms are less accurate following breast implants and about 8 per cent of breast tissue cannot be visualised after this operation. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

If you develop a breast lump, aspiration with a needle is not possible and you will require a biopsy instead.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.
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Planning your surgery

In your initial consultation, I will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, I may also recommend a breast lift.

Planning your surgery

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Preparing for your surgery

You will be given instructions to prepare for surgery, including guidelines on eating and drinking, smoking and medication.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Your operation will be performed under general anaesthesia and you will require an overnight admission to hospital.

Clinical photographs will be taken before your operation.
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The surgery

The method of inserting and positioning your implant will depend on your anatomy and my recommendation. The incision will be made usually in the crease where the breast meets the chest. Occasionally the cut is made around the nipple.

Incisions are made to keep scars as inconspicuous as possible: in the breast crease, around the nipple, or in the armpit. Breast tissue and skin is lifted to create a pocket for each implant.

Working through the incision, I will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall (pectoral) muscle. The implants are then centred beneath your nipples.

The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which will also be taped for greater support.

After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.
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After your surgery

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 hours. Most of your discomfort can be controlled by tablets prescribed and given to you to take home.

After your surgery

You will be able to bathe the next day and your tapes will be removed one week after surgery. You should wear a bra as directed. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Your stitches will absorb and won’t need to be removed, but the swelling in your breasts may take about two months to disappear.
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Getting back to normal

You should be able to return to work within two weeks depending on the level of activity required for your job.

You will be given advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore: usually three to four weeks after surgery.

Your scars will be firm and pink for about three months. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
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Your new look

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.

Your decision to have breast enlargement or augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If we’ve met your goals, then your surgery is a success.